Evaluation of a disability-inclusive ultra-poor graduation programme in Uganda: study protocol for a cluster-randomised controlled trial with process evaluation

Background There is little evidence on how to support ultra-poor people with disabilities to adopt sustainable livelihoods. The Disability-Inclusive Graduation (DIG) programme targets ultra-poor people with disabilities and/or women living in rural Uganda. The programme is an adaptation of an ultra-poor graduation model that has been shown to be effective in many contexts but not evaluated for people with disabilities. Methods The DIG programme works with project participants over a period of 18 months. Participants receive unconditional cash transfers for 6 months, training, access to savings-and-loans groups, and a capital asset that forms the basis of their new livelihood. The programme is also adapted to address specific barriers that people with disabilities face. Eligible households are clustered by geographical proximity in order to deliver the intervention. Eligibility is based on household screening to identify the ‘ultra-poor’ based on proxy means testing—both households with and without people with disabilities are included in the programme. Clusters are randomly selected prior to implementation, resulting in 96 intervention and 89 control clusters. The primary outcome of the trial is per-capita household consumption. Before the start of the intervention, a baseline household survey is conducted (November 2020) among project participants and those not offered the programme, a similar endline survey is conducted with participants with disabilities at the end of programme implementation in July 2022, and a second endline survey for all participants in October 2023. These activities are complemented by a process evaluation to understand DIG programme implementation, mechanisms, and context using complementary qualitative and quantitative methods. Ethical approval for the research has been received from Mildmay Uganda Research Ethics Committee and London School of Hygiene and Tropical Medicine. Discussion DIG is a promising intervention to evaluate for people with disabilities, adapted to be disability inclusive across programme components through extensive consultations and collaboration, and has proven efficacy at reducing poverty in other marginalised groups. However, evaluating a well-evidenced intervention among a new target group poses ethical considerations. Trial registration Registry for International Development Impact Evaluations, RIDIE-STUDY-ID-626008898983a (20/04/22). ISRCTN registry, ISRCTN78592382. Retrospectively registered on 17/08/2023. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-024-08040-w.

Section 2. Household Characteristics, Household Members Found in the Baseline I would like to begin by asking you some questions about the members of your household.
NOTE TO THE INTERVIEWER: Household members are all those who live under the same roof and share food for 6 months or more.2.13 Who is the head of the household?[Write HH member ID.] (s29) 2.14 Who is the respondent?2.15 Who is the primary beneficiary (index person)?

4.18
What was the actual cost of the improvement?

Livestock Activities
NOTE TO THE INTERVIEWER: Livestock can be owned exclusively or they can be reared in partnership with another HH, even where only one household is keeping that/those animals on their property, depending on whether the household uniquely provides the inputs for rearing that animal and can uniquely choose to sell that animal.Be careful of understanding this difference and capturing animals accurately.Remember that, just like questions on cultivation, for all questions regarding partnership in rearing livestock you should record only the HH's share, not the overall amount.
Household Alone: All of the following questions pertain to animals your HH owns exclusively.

Line
No.
[Type of livestock] How many [animals] do your HH have now?
In the last year how many [animals] did your HH consume?
[Type of animal product] In the last year did you produce [animal product] for animals owned?13.4 Did this person help answer questions?
Now I would like to ask you about your home and your household resources.Household Welfare4.1Howmany rooms for sleeping does your house have?This does not include kitchen, bathroom, etc.[If the household is a single undivided room, enter "1."] made any home improvements -such as repairs, adding rooms, etc.in the last 12 months?
more than 4 acres C = One half of an acre G = One and a half acres K = Three and a half acres D =Two thirds of an acre H 12= Peas 17=Okra (lady's fingers) 22 = Pineapple 3 = Rice 8 = Sim sim 13= Kale of Sukuma wiki 18 = Onions 23 = Cotton 4 = Irish potatoes 9 = Beans 14 = Local greens 19 = Tomatoes 24 = Tobacco 5= Sweet potatoes 10 = Soya beans 15 = Eggplants 20 = Carrots 96 = Other, specify 14.C A = One quarter of an acre B = One third of an acre C = One half of an acre D = Two thirds of an acre E = Three quarters of an acre F = One acre G = One and a half acres H = Two acres I = Two and a half acres J = Three acres K = Three and a half acres L = Four acres 961 = Other less than 4 acres 962 = Other more than 4 acres

Household Consumption and Expenditures
Now I would like to ask you the things that your household eats and often spends money on.
[Enter "0" if the improvement was done with local materials and HH labour.Enter "0" if there was no payment -either in cash or in kind -for materials or labour.Estimate the value of any payment NOTE TO INTERVIEWER: Animals captured here must be animals owned exclusively by the HH, not those that the HH is watching for others or owns in partnership.Owning exclusively means that the HH could sell these animals any time they choose without consulting others outside the HH.

s44a_23oth) Section 6. Household Agricultural and Livestock Activities
Now I would like to ask you about cultivation in the last year as a households.{bothseasons combined}

in the last one year?
6.12.A How many acres of land do the household own in total?[SEECODESBELOW] (s55a) 6.12.BWhat is the maximum number of acres of land that the household could cultivate on if they had the capital and the seeds, etc.?[SEE CODES BELOW]

Other Household Income-Generating Activities
Now I would like to ask you about income-generating activities you or anyone else in your household engages in.Ask for all HH members 15 years and above.Include each HH member on a separate line.
How much did your household receive from [assistance] in the last year?9.13How much did you give in gifts to other households in the last year?[inUGXor estimate value ifgiven in kind]

going to ask you some questions about your involvement in different aspects of family, social life and society. Please listen to each one and answer yes, no, sometimes, sometimes or not applicable.
Washington Group -Extended Question Set on Functioning (WG ES-F).2011; Available from: http://www.washingtongroup-disability.com/wpcontent/uploads/2016/01/WG_Extended_Question_Set_on_Functioning.pdf.WOULD YOU SAY YOU HAVE: NO DIFFICULTY, SOME DIFFICULTY, A LOT OF DIFFICULTY OR CANNOT DO AT ALL?

Environmental factors 6 I am going to ask you some general questions about your environment. I would like to know if the environment makes it easy or hard for you to do things you need or want. I want you to answer the following questions on a scale from 1 to 5, where 1 means very easy and 5 means very hard.
How many hours did you spend on visiting and meeting with others (including socializing with neighbours, meeting with friends at their homes or in trading center, attending wedding or other celebrations, etc.) last week?In general, apart from your children, how many other relatives do you have that you feel very close to?(people that you feel at ease with, can talk to about private matters, and call on for In general, how many very close friends do you have?(People that you feel at ease with, can talk to about private matters, and call on for help?) out of the house/ dwelling to attend social meetings, activities, weddings, events?b. …gotten out of the house/ dwelling to visit a relative, neighbour or friend?c. …had visitors to your house, such as friends, neighbours, and relatives?